HomeMy WebLinkAbout101105318 - PermitCity of Santa Ana 20 Civic Center Plaza (M-19), Santa Ana, CA\27O2 Building
Permit Counter: (714) 647-5800 lnspection Requests: (714\ 667-2738 lnspector Section: (714) 647-5853
Permit#: lOl{O53{8
Pin #: 93231t\{
Assessor's Parcel:108-374-09 Lot: 21
Unit Bldg: Address Range Suite Range;
Zoning: R'lBlock: NA Tract 3528 Historic: No
Building Use
Job Type:
Nature of Work:
Existing Bldg. & Use
Proposed Usel
Single Family Dwelling
Reroof
Reroof
SFD w/att Garage
1st FL Area:
2nd FL Area
Other Areas:
Garage Area
Total:
Description of Work: Tear offexisting roof material and install new comp shingle roof material. Owner-Builder form on file. Handoutgiven
Planning Conditions:
Occupancy:
Constr Type
Code:
Flood Zone:
# of Stories:
R.3, U
VB
cBc 2019
x-06023202s6J
Patio:
T.l.Area:
Yards Req'd:
Valuation: $'10,000.00
Owner
Address
Phone:
Tenant:
Rose Dinh
5017 W KENT AVE
Santa Ana, CA 927041937
(7',t4!. 414-2615
Contractor
Address:
Owner-Builder
Engineer
Addressl
Phone:
State Lic #:
Lic Type:
Bus. Lic #:
Workers' Compensation lnsurance
Carier:
Policy #:
Expires:
Phonel
License #:
Architect /
Desiqner:
Address:
Phone:
License #:
Planning Approval By:
Plan Checked By:
Permit lssued By:
NPDES lnsp. Req'd:
PWA lnsp. Req'd:
Planning lnsp. Req'd:
Landscaping lnsp. Req'd
Enriquez, Gissel
Chavez. Oa!,e Vt C,i,
Date: I l/30/2020
Date:
Oate: 11130/2020
Subject to Field:
Misc. Receipt
Misc. Receipt
Misc. Receipt
0 7776002
07776002
07776002
o7175002
0 771600 2
57607
57770
57672
57600
57607
$345.28
$4.05
$1.00
$23.79
$59.30
Permit Fee
Microfilm Records
Bldg. Stds. Revolving
General Plan Update
lssuance
Fire lnsp Req'd
Police lnsp Req'd
Flood Zone Cerl. Req'd: No
Every pernil issued shall bocome nvahd unless tho wo.k on lhe sile authoized by
such pemit is cofimenced wihin 360 days after its issuance.ot if the work authorized
on lhe site by such pemit is suspended or abandoned lor a period of 360 daysafter
lhe time lhe work ts cofifiencecl
No
No
No
No
No
No Account#Total
$433.42
$0.00
$433.42
lnspector MID#: 2020-162937
01 1 '!6002 51600
01 1 16002 51601
011 16002 51612
01116002 57770
$23.79
$404.58
$1.00
$4 05 Fee Total:
Pard to Date
Balance Due
Project Address: 5017 W Kent Ave
BUILDING. INSPECTOB RECORD
SITE.WORK DATE ID/SIG.COMMENTS
Sel Backs
Forms/Steel/Holdowns
Erection Pads
UFER Ground
SLAB Floor
Subf loor/Vent/lnsulation
Rool Sheathinq 7/z/z.u r4 *nr)
Shear Wall
Framinq
lnsulation/Energy
Drywall
Ext./lnt. Lath
Brown Coat
Masonry
Pool Fence
T-Bar
Handicap Req.
Deputy Final Report
Engineer Final Report
l I L rA.
FINAL I Ltr\l,\VryY'Y
Certificate of Occupancy
Notes, Remarks, Etc
OWNT:R IUTLDER D}:I-CATATION
I h.rb! rrluE trn,lcr Fulr, (, r'c4urr rhlr I d.kr{{ ft m !h. (i'nr&rtrr li(cn{ li* ntr rh. l,nkiwm! r..s,n (Se.70.t15
trusnc$ anl Ptor.$r)n (irl.) Any Cny or cnndy *h(h lcqurc\ . Ir!tul 'i, .onio!r. .trd. imrnvc. &frnrh u rcIlr Jny
dE trc,Fitr!'irl Nsth c. ilvr rNuu.\ rhc amli.dr ld \urh Fmrr h ,il. r rymd ${r.mnr lh.' lr or {t i h(nsd luruhr
r,, rhc prrv$nms ol rlr Conta.r, s l.rcnql Lxv (ClsB.r 9, CDmm in8 vnh SNri'n nIL ol Drvrn,. .l ol rh. Bus $ rnJ
lr.rcrsionNC,xrc)nrh,rhor\h.rsclcmp,rhscliomudrh.h!$st{rrhcrlkBcd.rcn{rrr Anyviol nnolS i,,n701!5hr.ny
ryl'unt n, rlfmn $hrlk rl* amlr. n,rovrlFMhyo!n r frn.rhrn ivc ho lr..l.loll.A r55{l,)
l[t. .o "**, "l rre pqtny, or hy .npLy&s v h *,3.' rr rh. v,L lomncngton. v l d' rt $rk rnl rh. 3tNtrm ir n{
nr.'rlcJ orollcrJ kr eLlS(.7lEl, Busurlr ul l\olc\sonsC,ic:'lhcConllucnt s l-rr[{ ti* dt.\ tror lptly nt .wncroi
rlt.pn,Fn] *lt, tio ls!{ rqmB rlmr .d *lrr rlk\ \kh sft h,mtlf d lErsll or rhnu3[ h!! or lEr ostr ctrq.l,,yc.s.
tbvd.d rhlr nEh inll'n,vcm l m r{ mrorlol r ',llcRrl li tr eL. ll. h,wcvc., rh. hr|lry or mt ,tm.r i\ v,l] * h,n ok Fr
ol unrohrin. rlrirlmr llxidd, har th. bu&n ol JIoenElhd lEor{h. dil B h!r! or Dyn)v. dr IlnIEry lir rtr lr4rk.I
-1.
dr.wnq ol rh. pmFny. rn.r.lhN.ly$nrrNrn! wlh l,r.ns.J (dr..trs tr on{ru( lh. troFi (SE.- l}l4.llorms
rd lhn6\roCo.L:Thr Ci,nrrNktr'\ l-(.n$L{wJ(rr mr.rrly l,) ownrrilp!,pcnyeh,rbu'ldstrrimpn'vrsrhcrcon
rnd who (nlrarrs nx rkt rr,r..r. r h.Ci, nd!,l n lf,cnt.J N^xdr n, rh. (ntunrois l..cnc ljs )
'tir _.1] & PC. n,rh'sr.,v'n
\o
!ECr,AEdU()!
I ltr.n) rrrnr untl.r C(n,lr!ot Fruryo'f, ol rlr,(JL,wot J(lird.nrl
I nrvc rd ulll mrnran nC.nrriur. or'Cinrr nr S.lrln{r. r,tr utrkdl rm|*n{ii.n. as [ovi,cJ nn bt Se.'r xr .u ]ol'lE
lihtr (i'1., lnrrhr F.nom,Rc ol rh( sorl ntrwhf,h rh. Frfrx a Nsnl
!r f,likn wlEhrh'\$rn r{ A!u.d Ml $orkqr (omlFNrrr,. rn'urJ'trtrMrr rrlJrn(y trunth.r u.
i7,,.n,,,'t,*'**r,,rmilr,rrr)r$'{rr',rhtrhth'!pcnnnrNq,cr.l\hruno,c,rpk,yrtryn nn riyhrinc'
!i ri !' trlo'r \uhr!r L, rhc krls\ (,mFnsrr r hw\nl Crlnomu. rntl llNc rhar 'l I rh,uU tr('m ubj(r l,rrh
n rr i.iin,Fn\, r,aax,yh tr.nrSrrrinrTrrri,rrlk.l"rh{C,rl( l.l!ll. rrh* h\^nfb *',hrh.r.t',*^tr.n\
WAlt\I\(; l?'lu'r h' y1'uu *, kc^' L,!n'Fn:Jrnrr (,nfl.rc r. ntrrwlul rl \hJll \uhF\r n cmnl,.}.r [, \mru, FMnr'. r
,^'l r c. f n',trx hunln'J rhnu\r,rl Jrll \ rll r,Ou)'. In .'J,l [nr|l, rhc ,,^r .r ,rnFh. nn,. Jin!P.. r\ fh'vd..l rn tli
s,.rr!' nr6t.rrhql-htr[,r]1.n.rrnr rltr,r] \r(. ll n
,,,,,. tll?olle ^",,,*,,,x J./'-x-x----.ITCENSSLTANITACIAB 'll!.L{,8arlaN
lllf,rh!nlinucrrnrl'rrrncrpryrlurlrml'!c.adnnJcrln,vsrrolCh,flqr)ronurh-.trr3!ltSr'rn7ul)rnlD,vr$ntrlnl rlf, lrunD-. dnJ P" .$,.!n (',,J1. snl n,j l'.cnn..\ f lull r,tr.c J'r crru\,
lhlc- linrlm.lur
coB$alcuoN.Lllullli {iE}lr
Ih.rchy.llnmu { F*nrl!,ol I'crFr.yrnar rhcE L1tr.o.nnf,tr knJu8 aScL y L, rhc Fl,trDnrc ol rh. eolt lnr {h*h rh6 Fmi 6
ssucd rsc( l(Yr?, Crv. C )
II'LICANT I'FCI ARATION
I ha{,y dnn' un,l.r p.nalr, ol Nlury o& ol lhc nn[,wnt tlc(lardrirns:
l)cfr,|'r on ltrn lAriE{os N"rfu.' tr,n ,qLr.l R.plnxor r llrk .r). Pd6)
It(qutrr'l Ixrtd ol Nd'lnJetr,
lrcnn! rhrr rlr kJ.rnl,clxlntotr. r.Frntr! rhn"'rcm)vrl r!. nor rndr$h !!
'hn Ix,*\r
?!I !r'!'1y rhi I 1$. r-tr1 rhN rt,l!l[rr!r rrrl {. . rlri rl!,rc hl.rn trr r! r.n(r I r!'e (, \rmll! * h.,ll C l xl (inN!
orJn'r'i.\ Jnll5rar! l.!s\ r.Lri[ rr hu.l.,r.Eq)niru(rr Lr(ht aurhd. rcF.knhnr.\ ol tlh C y dnl C.uDr, t' .nrg uFrn rtt
xh,vr nrnrrtrnl p!'Itny ntr fl\x(r!r purF\.\
\l,tlntrtrl or,\r.nl Sirnn (n(E D / tut+
r
1')
I
I
I
Flood Zone Cerlif .
Planning & Building Agency
Building Safety Division
20 Civic Center Plaza
P.O. Box 1988 (M-19)
Santa Ana, CA 92702
(714) 647-5800
www.santa-ana.org
APP-13 CBC 2016
Dear Property Owner:
NOTICE TO PROPERTY OWNER
bmitted i our na listing yourself as the builder of the property improvementsAn applicati
specified at
on for a building permit has been s v
We are providing you with an Owner-Builder Acknowledqment and lnformation Verification Form to make you aware of your
responsibilities and possible risk you may incur by having thas permit issued in your names as the Owner-Builder
We will not issue a building permit until you have read, initialed your understanding of each provision, signed, and returned this
form to us at our official address indicated. An agent ofthe ownercannot execute this notice unless you, the property owner,
obtain the prior approval of the permitting authority.
OWNER'S ACKNOWLEGMENT AN VERIFICATION OF INFORMATON
DIRECTIONS: Read and initial each statement below to signify you understand or verify this information
(0 1 I understand a frequent practice of unlicensed persons is to have the property owner obtain an "Owner-Builder" build-
ihg permrt that erroneously imples that the property owner is providing his or her own labor and material personally. l, as an
Owner-Builder, may be held liable and subject to serious flnancial risk for any injuries sustained by an unlicensed person and
his or her employees while working on my property. My homeownels insurance may not provide coverage for those injuries. I
am willfully acting as an Owner-Builder and am aware of the limits of my insurance coverage for injuries to workers on my prop-
erty.
(') 2. I understand buildinq permits are not required to be signed by property owners unless they are responsible for the
construction and are not hiring a licensed Contractor to assume this responsibility.
Er7 g. t understand as an "Owner-Builder" I am the responsible party of record on the permit. I understand that I may protect
myself from potential financial risk by hiring a licensed Contractor and having the permit filed in his or her name instead of my
own.
8-0. ,understand Contractors are required by law to be licensed and bonded in California and to list their license numbers
on permits and contracts.
f, 5 I understand if I employ or otheMlse engage any persons, other than California licensed Contractors, and the total
vdlue of my construction rs at least five hundred dollars ($500), including labor and materials, I may be considered an
"employer" under state and federal law.
EI-0. f understand if I am considered an "employer" under state and Federal law. I must regaster with the state and federal
government, withhold payroll taxes, provide workers' compensation disability insurance, and contribute to unemployment com-
pensation of each "employee." I also understand my failure to abide by these laws may subject me to serious flnancial risk.
&.. l. t u nderstand under California Contractors' State License Law, an Owner-Builder who builds single-family residential
structures cannot legally build them with the intent to offer them for sale, unless a/l work is performed by licensed subcontrac-
tors and the number of structures does not exceed four within any calendar years, or all of the work is performed under contract
with a licensed general building Contractor.
(/l 8. I understand as an Owner-Builder if I sell the property for which this permit is issued, I may be held liable for any finan-
cial or personal in.juries sustained by any subsequent owner(s) that result from any latent construction defects in the workman-
ship or materaals.
,' Il1 V)
l,l/ 9. I understand I may obtain more information regarding my obligalions as an "employer" from the lnternal Revenue Ser-
vice, the United States Small Business Administration, the California Department of Beneflt Payments, and the California Divi-
sion of lndustrial Accidents. I also understand I may contact the California Contractors' State License Board (CSLB) at 1 -800-
321-CSLB (2752) or www.cslb.ca.qov for more information about licensed contractors.
l{l 10. I am aware of and consent to an Owner-Builder building permit applied for in my name, and understand that I am the
party leg
d ress:
ally and fin anciallv\^/ k responsible for propo sed construction activit y at the following ad-
O
M ll.l agree that, as the party legally and financially responsible for this proposed construction activity, I wall abide by all
applicable laws and requirements that govern Owner-Builders as well as employers.
K0 lZ.l agree to notify the issuer of this form immediately of any additions, deletions, or changes to any of the information I
have provided on this form.
Licensed contractors are regulated by laws designed to protect the public. lf you contract with someone who does not have a
license, the Contractors' State License Board may be unable to assist you with any tlnancial loss you may sustain as a result of
a complaint. Your only remedy against unlicensed Contractors may be in civil court. lt is also important for you to understand
that if an unlicensed Contractor or employee of that individual or firm is injured while working on your property, you may be held
liable for damages. lf you obtain a permit as Owner-Bu jlder and wish to hire Contactors, you will be responsible for verifying
whether or not those Contractors are properly licensed and the status of their workers' compensation insurance coverage.
tion, or other verification acceptable to the aoencv is reduired to be presented when the permit is rssued to verifv the
propertv ow ne r's s i on atu re.
Signature of Property Owner Date: ttl:oln
Print name of Owner kklE T>, ru A
AUTHORIZATION OF AGENT TO ACT ON PROPERTY OWNER'S BEHALF
Excluding the Notice to Property Owner. the execution of which I understand is my personal responsibility, I hereby authonze
the following person(s) to act as my agent(s) to apply for, sign, and file the documents necessary to obtain an Owner-Builder
Permit for my project.
Scope of Construction Project (or Description of Work)
Name of Authorized Agent
Address of Authorized Agent
Phone Number of Authorized Agent
I declare under penalty of perjury that I am the property owner for the address listed above and I personally filled out the above
lnformation and certify its accuracy.
Property Owner's Signature Date
Print Name of Owner:
Note: A copy of the owner's driver's license, form notarization, or other verification acceptable to the agency is re-
quired to be presented when the permit is issued to verify the property owner's signature-
,f)
Before a building permit can be issued, this form must be completed and signed by the property owner and returned
to the agency responsible for issuing the permit. Nofe; A copv of the propertv owner's driver's license, form notariza-
)
Project Location or Address: